September 11, 2023
The U.S. Preventive Services Task Force (USPSTF) issued four preventive service recommendation statements – three revised statements and one new recommendation:
- The USPSTF recommends preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at increased risk of Human Immunodeficiency Virus (HIV) acquisition to decrease the risk of acquiring HIV. The updated recommendation is consistent with the prior 2019 recommendation and reflects the USPSTF’s review of additional evidence on newer injectable formulations of PrEP since the 2019 recommendation. This recommendation is effective for plan years beginning on or after August 22, 2024 (January 1, 2025 for calendar year plans).
Continue covering USPSTF “A” and “B” rated preventive services without cost-sharing.
- The USPSTF recommends a daily folic acid supplementation to prevent neural tube defects in all persons who are planning to or could become pregnant. The updated recommendation is consistent with the prior 2017 recommendation. It does not apply to persons who have had a previous pregnancy affected by neural tube defects or who are at very high risk due to other factors such as family history or those taking medication known to block the function of folic acid. This recommendation is effective for plan years beginning on or after August 1, 2024 (January 1, 2025 for calendar year plans).
- The USPSTF recommends screening for depression in adults, including pregnant and postpartum persons, and older adults (ages 65 or older). This recommendation is generally consistent with prior recommendations, but formally replaces the 2016 recommendation statement on screening for major depressive disorder (MDD) in adults. This recommendation is effective for plan years beginning on or after June 20, 2024 (January 1, 2025 for calendar year plans).
- The USPSTF recommends screening for anxiety disorders in adults ages 64 or younger, including pregnant and postpartum persons. This is a new recommendation by the USPSTF and is effective for plan years beginning on or after June 20, 2024 (January 1, 2025 for calendar year plans).
The Affordable Care Act (ACA) requires that most group health plans cover all preventive services with an “A” or “B” rating from the USPSTF without cost sharing (i.e., no copay, coinsurance, or deductible). Group health plans (with few exceptions) must cover these services by the effective dates identified above.
Business Group on Health has covered the ongoing Braidwood Management v. Becerra (Braidwood) litigation challenging the constitutionality of the USPSTF and ACA preventive services coverage requirements during our September 2022 and April 2023 Regulatory & Compliance webinars. As a brief summary:
- The U.S. District Court for the Northern District of Texas ruled that the appointment of the USPSTF violated the “Appointments” clause of the Constitution because the members of the task force were not properly appointed.
- The court’s ruling blocking the requirement nationwide that applicable plans and health insurance issuers cover preventive services recommended or updated by the USPSTF on or after March 23, 2010.
- In addition to ruling on the ACA preventive services coverage requirements, the court also held that the specific requirement to cover PrEP without cost sharing violated some of the Braidwood plaintiffs’ rights under the Religious Freedom Restoration Act. The court enjoined the Department of Labor Employee Benefits Security Administration (DOL/EBSA), Department of Health and Human Services (HHS), and Department of Treasury (collectively, the Departments) from implementing or enforcing the PrEP coverage requirement against these plaintiffs.
- The Departments issued Affordable Care Act (ACA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act Implementation FAQs Part 59 addressing the impact of the district court’s ruling.
At the time of writing, the U.S. 5th Circuit Court of Appeals has issued an administrative stay of the federal district court’s ruling. Therefore, as the litigation proceeds, employer plan sponsors must continue to cover USPSTF “A” and “B” rated services – including PrEP – without cost sharing. Business Group on Health will continue to monitor developments and update members on both USPSTF actions and the Braidwood litigation.
- USPSTF Final Recommendation Statement – Preexposure Prophylaxis to Prevent Acquisition of HIV
- USPSTF Final Recommendation Statement – Folic Acid Supplementation to Prevent Neural Tube Defects
- USPSTF Final Recommendation Statement – Anxiety Disorders in Adults: Screening
- USPSTF Final Recommendation Statement – Depression and Suicide Risk in Adults: Screening
- USPSTF List of “A” and “B” Recommendations
If you have questions, comments, or concerns about these or other regulatory and compliance issues, please contact us.
We provide this material for informational purposes only; it is not a substitute for legal advice.